超声心动图联合实验室检查预测静脉注射丙种球蛋白无反应性川崎病的价值

doi:10.3877/cma.j.issn.2095-655X.2025.01.008

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1058 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨超声心动图(UCG)联合实验室检查在预测静脉注射丙种球蛋白（IVIG）治疗无反应性川崎病（KD）中的应用价值。方法收集2019年9月至2023年9月成都市妇女儿童中心医院儿童心脏内科收治的164例KD患儿，依据对IVIG治疗的敏感情况，分为IVIG无反应组（n=82）和IVIG反应组（n=82）。比较两组治疗前UCG表现、实验室检查指标，并采用多因素Logistic回归预测发生IVIG无反应的高危因素，绘制受试者操作特征（ROC）曲线，评价预测效能。结果IVIG无反应组冠状动脉（CA）扩张比例比IVIG反应组更高［37.80%(31/82)，20.73%(17/82)］，差异有统计学意义（χ2=5.773，P=0.016）。三尖瓣反流（TR）、丙氨酸氨基转氨酶（ALT）＞40U/L、白蛋白（ALB）＜35g/L、D-二聚体（D-Dimer）＞0.5mg/L、中性粒细胞与淋巴细胞计数比值（NLR）＞1.29、血小板（PLT）＞420×109/L、血小板与淋巴细胞计数比值（PLR）＞126.8是发生IVIG无反应的独立危险因素［OR=19.136(95%CI:3.634～100.756)，1.016(95%CI:1.007～1.025)，0.912(95%CI:0.835～0.996)，1.780(95%CI:1.091～2.904)，0.812(95%CI:0.681～0.969)，1.014(95%CI:1.007～1.022)，1.022(95%CI:1.006～1.037);均P＜0.05］。双联合中TR联合PLT的ROC曲线下面积为0.850，敏感度为63.41％，特异度为95.12％；三联合中TR联合ALT及PLT的ROC曲线下面积为0.903，敏感度为80.49％，特异度为86.59％；多联合中TR联合ALT、PLT、ALB、D-Dimer及PLR共6项指标的ROC曲线下面积为0.946，敏感度为86.59％，特异度为92.68％。结论KD患儿CA扩张、TR、ALT水平升高、ALB降低、D-Dimer升高、NLR升高、PLT升高、PLR升高、血沉升高等是发生IVIG无反应的高危因素。UCG联合实验室检查可为预测IVIG无反应发生提供更准确的价值。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：川崎病, 丙种球蛋白, 无反应, 超声心动图, 危险因素

Abstract：ObjectiveTo investigate the application value of echocardiography (UCG) combined with laboratory examination in predicting unresponsive Kawasaki disease (KD) intravenous immunoglobulin (IVIG) treatment. MethodsThe data of total of 164 children with KD admitted to the Children′s Cardiography Department of Chengdu Women and Children′s Central Hospital from September 2019 to September 2023 were collected.According to the sensitivity to IVIG treatment, the children were divided into the IVIG non-response group (n=82) and the IVIG response group (n=82). The UCG performance and laboratory examination indexes before treatment were compared between the two groups. Multivariate Logistic regression was used to predict the risk factors for IVIG non-response, and receiver operating characteristic (ROC) curve was drawn to evaluate the prediction efficacy. ResultsThe proportion of coronary artery (CA) dilation in the IVIG non-response group was higher than that in the IVIG response group ［37.80%(31/82), 20.73%(17/82)］, and the difference was statistically significant (χ2=5.773, P=0.016). Tricuspid regurgitation (TR), alanine aminotransferase (ALT)＞40U/L, albumin (ALB)＜35g/L, D-Dimer＞0.5mg/L, neutrophil to lymphocyte ratio (NLR) ＞1.29, platelet (PLT) ＞420×109/L, platelet and lymphocyte ratio (PLR)＞126.8 were independent risks factors for IVIG non-response ［OR=19.136(95%CI: 3.634-100.756)，1.016(95%CI:1.007-1.025)，0.912(95%CI:0.835-0.996)，1.780(95%CI:1.091-2.904)，0.812(95%CI:0.681-0.969)，1.014(95%CI:1.007-1.022)，1.022(95%CI:1.006-1.037), all P＜0.05］. The area under the ROC curve of TR combined with PLT was 0.850, the sensitivity was 63.41%, and the specificity was 95.12%. The area under the ROC curve of TR combined with ALT and PLT was 0.903, the sensitivity was 80.49%, and the specificity was 86.59%. The area under the ROC curve of TR combined with ALT, PLT, ALB, D-Dimer and PLR was 0.946, the sensitivity was 86.59%, and the specificity was 92.68%. ConclusionsCA dilation, TR, ALT elevation, ALB reduction, D-Dimer elevation, NLR elevation, PLT elevation, PLR elevation, erythrocyte sedimentation rate elevation are high-risk factors for IVIG non-response in KD patients. UCG combined with laboratory testing provide a more accurate method for predicting IVIG non-response.

Key words： Kawasaki disease Gamma globulin No response Ultrasonocardiography Risk factor

收稿日期: 2024-11-04

基金资助:成都市卫健委科研项目（2021131）

通讯作者: 刘健，Email：19950370072@qq.com

引用本文:

文杨刘健姚海波金梅杨胜马荣川. 超声心动图联合实验室检查预测静脉注射丙种球蛋白无反应性川崎病的价值[J]. 中华诊断学电子杂志, 2025, 13(1): 51-58.
Wen Yang1, Liu Jian2, Yao Haibo3, Jin Mei1, Yang Sheng1, Ma Rongchuan1.. The value of echocardiography combined with laboratory examination in predicting intravenous immunoglobulin unresponsive Kawasaki disease. zhzdx, 2025, 13(1): 51-58.

链接本文:

http://www.zhzdxzz.com/CN/10.3877/cma.j.issn.2095-655X.2025.01.008 或 http://www.zhzdxzz.com/CN/Y2025/V13/I1/51

［1］Newburger JW，Takahashi M，Burns JC.Kawasaki Disease［J］.J Am Coll Cardiol，2016，67(14):1738-1749.DOI：10.1016/j.jacc.2015.12.073. ［2］中华医学会儿科学分会心血管学组，中华医学会儿科学分会风湿学组，中华医学会儿科学分会免疫学组，等.川崎病诊断和急性期治疗专家共识［J］.中华儿科杂志，2022，60(1):6-13.DOI：10.3760/cma.j.cn112140-20211018-00879. ［3］McCrindle BW，Rowley AH，Newburger JW，et al.Diagnosis，treatment，and long-term management of kawasaki disease：a scientific statement for health professionals from the American Heart Association［J］.Circulation，2017，135(17):e927-e999.DOI：10.1161/CIR.0000000000000484. ［4］林瑶，李晓惠，石琳，等.2017年版《川崎病的诊断、治疗及远期管理-美国心脏协会对医疗专业人员的科学声明》解读［J］.中国实用儿科杂志，2017，32(9):641-648.DOI：10.19538/j.ek2017090601. ［5］Maccora I，Calabri GB，Favilli S，et al.Long-term follow-up of coronary artery lesions in children in Kawasaki syndrome［J］.Eur J Pediatr，2021，180(1):271-275.DOI：10.1007/s00431-020-03712-6. ［6］王雷，夏焙.超声心动图在川崎病诊断、治疗及长期随访中的应用进展-2017年AHA指南的解读［J/CD］.中华医学超声杂志（电子版），2019，16(3):161-165.DOI：10.3877/cma.j.issn.1672-6448.2019.03.001. ［7］张清友，简佩君，杜军保.风湿热、心内膜炎及川崎病委员会,美国心脏病学会及美国儿科学会川崎病的诊断、治疗及长期随访指南介绍［J］.实用儿科临床杂志，2012，27(13):1049-1056.DOI：10.3969/j.issn.1003-515X.2012.13.029. ［8］Angkananard T，Anothaisintawee T，McEvoy M，et al.Neutrophil lymphocyte ratio and cardiovascular disease risk：a systematic review and meta-analysis［J］.Biomed Res Int，2018（2018）:2703518.DOI：10.1155/2018/2703518. ［9］袁迎第,孙军,李鹏飞,等.中性粒细胞与淋巴细胞比值及血小板与淋巴细胞比值对于川崎病IVIG敏感性的预测价值［J］.中国当代儿科杂志,2017,19(4):410-413.DOI:10.7499/j.issn.1008-8830.2017.04.010. ［10］Qian W， Tang Y， Yan W， et al. A comparison of efficacy of six prediction models for intravenous immunoglobulin resistance in Kawasaki disease［J］.Ital J Pediatr，2018，44(1):33.DOI：10.1186/s13052-018-0475-z. ［11］Lopez L，Colan S，Stylianou M，et al.Relationship of echocardiographic Z scores adjusted for body surface area to age，sex，race，and ethnicity：the pediatric heart network normal echocardiogram database［J］.Circ Cardiovasc Imaging，2017，10(11)：e006979.DOI：10.1161/CIRCIMAGING.117.006979. ［12］中华医学会儿科学分会心血管学组，中华儿科杂志编辑委员会.川崎病冠状动脉病变的临床处理建议（2020年修订版）［J］.中华儿科杂志，2020，58(9):718-724.DOI：10.3760/cma.j.cn112140-20200422-00421. ［13］夏焙,许娜,何学智,等.儿童超声心动图冠状动脉正常参考值及临床意义［J/CD］.中华医学超声杂志（电子版）,2013，(1):42-51. ［14］Friedman KG，Gauvreau K，Hamaoka-Okamoto A，et al.Coronary artery aneurysms in Kawasaki disease：risk factors for progressive disease and adverse cardiac events in the US population［J］.J Am Heart Assoc，2016，5(9)：e003289.DOI：10.1161/JAHA.116.003289. ［15］Burns JC，Hoshino S，Kobayashi T.Kawasaki disease：an essential comparison of coronary artery aneurysm criteria［J］.Lancet Child Adolesc Health，2018，2(12):840-841.DOI：10.1016/S2352-4642(18)30334-1. ［16］牛超，王琳琳，贾尝，等.川崎病发生机制研究［J］.中国小儿急救医学，2020，27(9):645-649.DOI：10.3760/cma.j.issn.1673-4912.2020.09.002. ［17］鲁炜慧，杜忠东，赵地，等.基于北京市儿童川崎病6年流行病学资料的实验室指标分析［J］.中国循证儿科杂志，2008，3(5):356-361.DOI：10.3969/j.issn.1673-5501.2008.05.007. ［18］陈芃螈，杨超，李刚，等.系统性免疫-炎症指数对川崎病患儿冠脉扩张的预测价值［J］.中国免疫学杂志，2020，36(16):2003-2006.DOI：10.3969/j.issn.1000-484X.2020.16.017. ［19］王程浩，刘芳.川崎病所致冠状动脉病变的病理改变及结局［J］.中华实用儿科临床杂志，2021，36(22):1757-1760.DOI：10.3760/cma.j.cn101070-20210510-00513. ［20］乐园，刘桂英，赵梓文.静脉注射免疫球蛋白无反应性川崎病的危险因素分析［J］.中国医药，2018，13(4):582-586.DOI：10.3760/cma.j.issn.1673-4777.2018.04.026. ［21］Yan Y，Qiao L，Hua Y，et al.Predictive value of Albumin-Bilirubin grade for intravenous immunoglobulin resistance in a large cohort of patients with Kawasaki disease：a prospective study［J］.Pediatr Rheumatol Online J，2021，19(1):147.DOI：10.1186/s12969-021-00638-7. ［22］Li X，Chen Y，Tang Y，et al.Predictors of intravenous immunoglobulin-resistant Kawasaki disease in children：a meta-analysis of 4442 cases［J］.Eur J Pediatr，2018，177(8):1279-1292.DOI：10.1007/s00431-018-3182-2. ［23］Muto T，Masuda Y，Numoto S，et al.White blood cell and neutrophil counts and response to intravenous immunoglobulin in kawasaki disease［J］.Glob Pediatr Health，2019（6）:2333794X19884826.DOI：10.1177/2333794X19884826. ［24］Kurtul A， Acikgoz SK. Usefulness of mean platelet volume-to-lymphocyte ratio for predicting angiographic no-reflow and short-term prognosis after primary percutaneous coronary intervention in patients with ST-Segment elevation myocardial infarction［J］.Am J Cardiol，2017，120(4):534-541.DOI：10.1016/j.amjcard.2017.05.020. ［25］Yan F，Pan B，Sun H，et al.Risk factors of coronary artery abnormality in children with kawasaki disease：a systematic review and meta-analysis［J］.Front Pediatr，2019（7）:374.DOI：10.3389/fped.2019.00374. ［26］杜忠东，赵地，杜军保，等.静脉注射丙种球蛋白应用时间对川崎病疗效的影响［J］.中华医学杂志，2009，89(26):1841-1843.DOI：10.3760/cma.j.issn.0376-2491.2009.26.014. ［27］Campbell AJ，Burns JC.Adjunctive therapies for Kawasaki disease［J］.J Infect，2016（72 Suppl）:S1-S5.DOI：10.1016/j.jinf.2016.04.015. ［28］Shashaani N，Shiari R，Karimi A，et al.Determination of the relationship between kobayashi，sano，and egami criteria and prevalence of intravenous immunoglobulin resistance and coronary artery aneurysm in iranian children with kawasaki disease［J］.Open Access Rheumatol，2020（12）:187-192.DOI：10.2147/OARRR.S255138.